Parotid Gland Injury-Related Sialorrhea Treated with Botulinum Toxin Type A injection

以甲型肉毒桿菌毒素治療外傷所致之腮腺損傷

張容輔(Jung-Fu Chang) ； 林上熙(Shang-Hsi Lin) ； 陳柵君(Cha-Chun Chen) ； 林煌基(Hwang-Chi Lin) ； 鄭舉緒(Chu-Hsu Jeng) ； 林育賢(Yu-Hsien Lin)

《臺灣整形外科醫學會雜誌》 28卷2期 (2019/06) Pp. 137-142

摘要

Background: Trauma-related parotid gland and duct injuries have low incidence rates; however, once they occur, late complications, such as sialocele and fistula, can be difficult to manage. In addition to conservative treatments, such as ice packing and compression, the use of botulinum toxin type A injection has been reported. Aims and Objectives: We experienced the case of a patient with trauma-related sialorrhea who was successfully treated with botulinum toxin type A injection under ultrasonographic guidance in the early phase. Materials and Methods: Our patient was a 19-year-old male, who sustained an open right zygomaticomaxillary fracture after a traffic accident. After open reduction and internal fixation of the fracture, 2 drainage tubes were placed. However, a large fluid volume was noted from one of the drainage tubes. Amylase level in the fluid was high at 575,200 IU/mL. Thus, we diagnosed the patient with sialorrhea. To accelerate wound healing and prevent further complications, 50 U of botulinum toxin type A was injected under ultrasonographic guidance. Results: The volume of drainage fluid decreased quickly after the injection. The amylase level was 5,080 IU/mL 6 days later, indicating improvement of sialorrhea. Both drainage tubes were subsequently removed. The patient recovered within 1 week, and no complaint was noted at 1-year follow-up. Conclusion: Botulinum toxin type A injection might be useful for the treatment of not only sialocele and fistula but also sialorrhea. Ultrasonographic guidance helps identify appropriate injection location and reduce the overall dose. The same approach might be useful for both traumatic and iatrogenic cases.

關鍵字

parotid gland injury ； sialorrhea ； botulinum toxin type A

並列摘要

背景：外傷所致的腮腺及腮腺管損傷的比率極低，但是若有併發症，如唾液囊腫或是瘻管形成，會極難處理。傳統以保守性的冰敷和加壓是第一線的處理方法，再者就是手術。近年來有不少案例嘗試用甲型肉毒桿菌毒素治療此類併發症，皆有相當不錯的療效。目的及目標：利用甲型肉毒桿菌毒素治療因為在一週前右側開放性顏面骨折導致的口水外露現象。我們亦搜尋現有治療文獻以佐證此方法。材料及方法：此病患因為外傷致右側開放性顏面骨骨折，但是在骨折治療六天後，由臉上放置的引流管流出大量清澈液體，經檢驗後證實為唾液外漏。在超音波儀器的指引下，我們利用50U甲型肉毒桿菌毒素注射。結果：注射治療後，引流量在三天內迅速減少。我們在六天後再度檢驗其amylase濃度，證實急遽降低。經治療並追蹤一年後，病患並無其他明顯併發症。結論：甲型肉毒桿菌毒素用在治療唾液外漏的現象，不僅可以用在晚期的併發症，其實可以在一旦確診時就使用。此外，用超音波確認腮腺管的位置和腮腺損傷部位，相較於過去盲目的注射甲型肉毒桿菌毒素，可以以較低的治療劑量達成同樣有效的治療結果。